Medicare

What is the difference between Medicare Part A & Part B?

Medicare Part A administers payment for inpatient and outpatient hospitals, Skilled Nursing Facilities (SNF), Comprehensive Outpatient Rehabilitation Facilities (CORF), rehabilitation facilities, hospice and some home health care. An individual Medicare provider number is not required for an occupational or physical therapist to bill for services in these settings. Billing is performed on the CMS-1450 (also known as the UB04) form.

Medicare Part B administers payment for doctor’s services, private practice therapy clinics, some home health care services and medically necessary supplies. Occupational and physical therapists are required to have their own Medicare number (now the NPI) in order to bill for services in these facilities. A group number can be applied for if there are two or more locations in the practice. Each location will need to have its own group number, which is associated with their Federal Tax ID number. The providers must have an NPI number. Billing is performed using the CMS-1500 form and Part B coding rules apply. The NPI number goes in block 24 J of the CMS 1500 form, and the group number goes in block 33 of the CMS 1500 form. The federal tax ID number goes in Box 25 on the CMS 1500 form.

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